The Bureau of Pharmacy Diagnosis Codes - Medicaid

1 The Bureau of Pharmacy Diagnosis Codes ICD-9 and ICD-10 Codes for Point of Sale and SmartPA . v1. 9/9/2015. ICD-9 & ICD-10 Codes CONTENTS. 2. Cystic Fibrosis Agents .. 4. 4. Suboxone/Subutex .. 7. Opioid Dependence .. 7. Pregnancy Codes for Subutex .. 8. Xarelto 10 mg .. 12. v1 Page 1 of 12. 9/9/2015. ICD-9 & ICD-10 Codes Brilinta (ticagrelor). Effient (prasugrel). Unstable Angina STEMI/NSTEMI. ICD9 Diagnosis Implementation Date 410 acute MYOCARDIAL INFARCTION acute MYOCARDIAL INFARCTION ANTEROLATERAL WALL acute MI ANTEROLATERAL WALL EPISODE OF CARE UNSPECIFIED acute MI ANTEROLATERAL WALL INITIAL EPISODE OF CARE acute MI ANTEROLATERAL WALL SUBSQT EPISODE OF CARE acute MYOCARDIAL INFARCTION OTHER ANTERIOR WALL acute MYOCARD INFARCTION OF OTHER ANTERIOR WALL EPISODE OF CARE UNSPECIFIED acute MYOCARD INFARCTION OF OTHER ANTERIOR WALL INITIAL EPISODE OF CARE acute MI OF OTHER ANTERIOR WALL SUBSQT EPISODE OF CARE acute MYOCARDIAL INFARCTION INFEROLATERAL WALL acute MI INFEROLATERAL WALL EPISODE OF CARE UNSPECIFIED acute MI INFEROLATERAL WALL INITIAL EPISODE OF CARE acute MI INFEROLATERAL WALL SUBSQT EPISODE OF CARE acute MYOCARDIAL INFARCTION INFEROPOSTERIOR WALL acute MI INFEROPOSTERIOR WALL EPISODE OF CARE UNSPECIFIED acute MI INFEROPOSTERIOR WALL INITIAL EPISODE OF CARE acute MI INFEROPOSTERIOR WALL SUBSQT EPISODE OF CARE acute MYOCARDIAL INFARCTION OTHER INFERIOR

2 WALL acute MYOCARDIAL INFARCTION OTHER INFERIOR WALL EPISODE OF CARE UNSPECIFIED acute MYOCARDIAL INFARCTION OTHER INFERIOR WALL INITIAL EPISODE OF CARE acute MI OTHER INFERIOR WALL SUBSQT EPISODE OF CARE acute MYOCARDIAL INFARCTION OTHER LATERAL WALL acute MYOCARDIAL INFARCTION OTHER LATERAL WALL EPISODE OF CARE UNSPECIFIED acute MYOCARDIAL INFARCTION OTHER LATERAL WALL INITIAL EPISODE OF CARE acute MI OTHER LATERAL WALL SUBSQT EPISODE OF CARE acute MYOCARDIAL INFARCTION TRUE POSTERIOR WALL INFARCTION acute MI TRUE POSTERIOR WALL INFARCTION EPISODE OF CARE UNSPECIFIED acute MI TRUE POST WALL INFARCTION INITIAL EPISODE OF CARE acute MI TRUE POSTERIOR WALL INFARCTION SUBSQT EPISODE OF CARE acute MYOCARDIAL INFARCTION SUBENDOCARDIAL INFARCTION acute MI SUBENDOCARDIAL INFARCTION EPISODE OF CARE UNSPECIFIED acute MI SUBENDOCARDIAL INFARCTION INITIAL EPISODE OF CARE acute MI SUBENDOCARDIAL INFARCTION SUBSQT EPISODE OF CARE acute MYOCARDIAL INFARCTION OTHER SPECIFIED SITES v1 Page 2 of 12.

3 9/9/2015. ICD-9 & ICD-10 Codes Brilinta (ticagrelor). Effient (prasugrel). Unstable Angina continued STEMI/NSTEMI. ICD9 Diagnosis Implementation Date acute MYOCARD INFARCTION OTHER SPECIFIED SITES EPISODE OF CARE UNSPECIFIED acute MYOCARD INFARCTION OTHER SPECIFIED SITES INITIAL EPISODE OF CARE acute MYOCARD INFARCTION OTHER SITE SUBSQT EPISODE OF CARE acute MYOCARDIAL INFARCTION UNSPECIFIED SITE acute MYOCARD INFARCTION UNSPECIFIED SITE EPISODE OF CARE UNSPECIFIED acute MYOCARD INFARCTION UNSPECIFIED SITE INITIAL EPISODE OF CARE acute MYOCARD INFARCTION UNSPECIFIED SITE SUBSQT EPISODE OF CARE 411 OTHER acute &SUBACUTE FORMS ISCHEMIC HEART DISEASE POSTMYOCARDIAL INFARCTION SYNDROME POST MI SYNDROME INTERMEDIATE CORONARY SYNDROME INTERMED CORONARY SYNDROME acute CORONARY OCCLUSION WITHOUT MYOCARDIAL INFARCTION OTHER acute AND SUBACUTE FORMS OF ISCHEMIC HEART DISEASE 412 OLD MYOCARDIAL INFARCTION OLD MYOCARDIAL INFARCTION ICD10 Diagnosis Implementation Date I200 UNSTABLE ANGINA I25110 ASHD NATIVE COR ART W/UNSTABLE ANGINA PECTORIS I25700 ATHEROSCLEROSIS CABG UNS UNSTABL ANGINA PECTORIS

4 I25710 ATHEROSCLEROSIS AUTOLOG VEIN CABG W/UNSTABLE AP I25720 ATHEROSCLEROSIS AUTOLOG ART CABG W/UNSTABLE AP I25730 ATHEROSCLEROSIS NONAUTOLOG BIOL CABG W/UNSTBL AP I25750 ATHEROSCLER NATV COR ART TPLNT HRT W/UNSTABLE AP I25760 ATHEROSCLER BP GRAFT COR ART TPLNT HRT UNSTBL AP I25790 ATHEROSCLER OTH COR ART BP GRAFT W/UNSTABLE AP v1 Page 3 of 12. 9/9/2015. ICD-9 & ICD-10 Codes Cystic Fibrosis Agents Cystic Fibrosis ICD9 Diagnosis Implementation Date CYSTIC FIBROSIS CYSTIC FIBROSIS WITHOUT MENTION MECONIUM ILEUS CYSTIC FIBROSIS WITH MECONIUM ILEUS CYSTIC FIBROSIS WITH PULMONARY MANIFESTATIONS CYSTIC FIBOSIS WITH GASTROINTESTINAL MANIFESTIONS CYSTIC FIBROSIS WITH OTHER MANIFESTATIONS ICD10 Diagnosis Implementation Date E840 CYSTIC FIBROSIS WITH PULMONARY MANIFESTATIONS E8411 MECONIUM ILEUS IN CYSTIC FIBROSIS E8419 CYSTIC FIBROSIS W/OTH INTESTINAL MANIFESTATIONS E848 CYSTIC FIBROSIS WITH OTHER MANIFESTATIONS E849 CYSTIC FIBROSIS UNSPECIFIED nimodipine tablets and liquid ICD9 Diagnosis Implementation Date 430 SUBARACHNOID HEMORRHAGE SUBARACHNOID HEMORRHAGE FOLLOWING INJURY, WITHOUT MENTION OF OPEN.

5 INTRACRANIAL WOUND, UNSPECIFIED STATE OF CONSCIOUSNESS SUBARACHNOID HEMORRHAGE FOLLOWING INJURY, WITHOUT MENTION OF OPEN. INTRACRANIAL WOUND, NO LOSS OF CONSCIOUSNESS SUBARACHNOID HEMORRHAGE FOLLOWING INJURY, WITHOUT MENTION OF OPEN. INTRACRANIAL WOUND, BRIEF (LESS THAN 1 HOUR) LOSS OF CONSCIOUSNESS SUBARACHNOID HEMORRHAGE FOLLOWING INJURY, WITHOUT MENTION OF OPEN. INTRACRANIAL WOUND, MODERATE (1-24 HOURS) LOSS OF CONSCIOUSNESS SUBARACHNOID HEMORRHAGE FOLLOWING INJURY, WITHOUT MENTION OF OPEN. INTRACRANIAL WOUND, PROLONGED (MORE THAN 24 HOURS) LOSS OF CONSCIOUSNESS. AND RETURN TO PRE-EXISTING CONSCIOUS LEVEL SUBARACHNOID HEMORRHAGE FOLLOWING INJURY, WITHOUT MENTION OF OPEN. INTRACRANIAL WOUND, PROLONGED (MORE THAN 24 HOURS) LOSS OF CONSCIOUSNESS, WITHOUT RETURN TO PRE-EXISTING CONSCIOUS LEVEL SUBARACHNOID HEMORRHAGE FOLLOWING INJURY, WITHOUT MENTION OF OPEN. INTRACRANIAL WOUND, LOSS OF CONSCIOUSNESS OF UNSPECIFIED DURATION SUBARACHNOID HEMORRHAGE FOLLOWING INJURY, WITHOUT MENTION OF OPEN.

6 INTRACRANIAL WOUND, UNSPECIFIED CONCUSSION SUBARACHNOID HEMORRHAGE FOLLOWING INJURY, WITH OPEN INTRACRANIAL WOUND, UNSPECIFIED STATE OF CONSCIOUSNESS SUBARACHNOID HEMORRHAGE FOLLOWING INJURY, WITH OPEN INTRACRANIAL WOUND, NO LOSS OF CONSCIOUSNESS v1 Page 4 of 12. 9/9/2015. ICD-9 & ICD-10 Codes continued nimodipine tablets and liquid ICD9 Diagnosis Implementation Date SUBARACHNOID HEMORRHAGE FOLLOWING INJURY, WITH OPEN INTRACRANIAL WOUND, BRIEF (LESS THAN 1 HOUR) LOSS OF CONSCIOUSNESS SUBARACHNOID HEMORRHAGE FOLLOWING INJURY, WITH OPEN INTRACRANIAL WOUND, MODERATE (1-24 HOURS) LOSS OF CONSCIOUSNESS SUBARACHNOID HEMORRHAGE FOLLOWING INJURY, WITH OPEN INTRACRANIAL WOUND, PROLONGED (MORE THAN 24 HOURS) LOSS OF CONSCIOUSNESS AND RETURN TO PRE- EXISTING CONSCIOUS LEVEL SUBARACHNOID HEMORRHAGE FOLLOWING INJURY, WITH OPEN INTRACRANIAL WOUND, PROLONGED (MORE THAN 24 HOURS) LOSS OF CONSCIOUSNESS, WITHOUT RETURN TO PRE- EXISTING CONSCIOUS LEVEL SUBARACHNOID HEMORRHAGE FOLLOWING INJURY, WITH OPEN INTRACRANIAL WOUND, LOSS OF CONSCIOUSNESS OF UNSPECIFIED DURATION SUBARACHNOID HEMORRHAGE FOLLOWING INJURY, WITH OPEN INTRACRANIAL WOUND, UNSPECIFIED CONCUSSION SUBDURAL HEMORRHAGE FOLLOWING INJURY, WITHOUT MENTION OF OPEN INTRACRANIAL.

7 WOUND, UNSPECIFIED STATE OF CONSCIOUSNESS SUBDURAL HEMORRHAGE FOLLOWING INJURY, WITHOUT MENTION OF OPEN INTRACRANIAL. WOUND, NO LOSS OF CONSCIOUSNESS SUBDURAL HEMORRHAGE FOLLOWING INJURY, WITHOUT MENTION OF OPEN INTRACRANIAL. WOUND, BRIEF (LESS THAN ONE HOUR) LOSS OF CONSCIOUSNESS SUBDURAL HEMORRHAGE FOLLOWING INJURY, WITHOUT MENTION OF OPEN INTRACRANIAL. WOUND, MODERATE (1-24 HOURS) LOSS OF CONSCIOUSNESS SUBDURAL HEMORRHAGE FOLLOWING INJURY, WITHOUT MENTION OF OPEN INTRACRANIAL. WOUND, PROLONGED (MORE THAN 24 HOURS) LOSS OF CONSCIOUSNESS AND RETURN TO. PRE-EXISTING CONSCIOUS LEVEL SUBDURAL HEMORRHAGE FOLLOWING INJURY, WITHOUT MENTION OF OPEN INTRACRANIAL. WOUND, PROLONGED (MORE THAN 24 HOURS) LOSS OF CONSCIOUSNESS, WITHOUT RETURN. TO PRE-EXISTING CONSCIOUS LEVEL SUBDURAL HEMORRHAGE FOLLOWING INJURY, WITHOUT MENTION OF OPEN INTRACRANIAL. WOUND, LOSS OF CONSCIOUSNESS OF UNSPECIFIED DURATION SUBDURAL HEMORRHAGE FOLLOWING INJURY, WITHOUT MENTION OF OPEN INTRACRANIAL. WOUND, UNSPECIFIED CONCUSSION SUBDURAL HEMORRHAGE FOLLOWING INJURY, WITH OPEN INTRACRANIAL WOUND, STATE.

8 OF CONSCIOUSNESS UNSPECIFIED SUBDURAL HEMORRHAGE FOLLOWING INJURY, WITH OPEN INTRACRANIAL WOUND, NO. LOSS OF CONSCIOUSNESS SUBDURAL HEMORRHAGE FOLLOWING INJURY, WITH OPEN INTRACRANIAL WOUND, BRIEF. (LESS THAN 1 HOUR) LOSS OF CONSCIOUSNESS SUBDURAL HEMORRHAGE FOLLOWING INJURY, WITH OPEN INTRACRANIAL WOUND, MODERATE (1-24 HOURS) LOSS OF CONSCIOUSNESS SUBDURAL HEMORRHAGE FOLLOWING INJURY, WITH OPEN INTRACRANIAL WOUND, PROLONGED (MORE THAN 24 HOURS) LOSS OF CONSCIOUSNESS AND RETURN TO PRE- EXISTING CONSCIOUS LEVEL v1 Page 5 of 12. 9/9/2015. ICD-9 & ICD-10 Codes continued nimodipine tablets and liquid ICD9 Diagnosis Implementation Date SUBDURAL HEMORRHAGE FOLLOWING INJURY, WITH OPEN INTRACRANIAL WOUND, PROLONGED (MORE THAN 24 HOURS) LOSS OF CONSCIOUSNESS, WITHOUT RETURN TO PRE- EXISTING CONSCIOUS LEVEL SUBDURAL HEMORRHAGE FOLLOWING INJURY, WITH OPEN INTRACRANIAL WOUND, LOSS OF. CONSCIOUSNESS OF UNSPECIFIED DURATION SUBDURAL HEMORRHAGE FOLLOWING INJURY, WITH OPEN INTRACRANIAL WOUND, UNSPECIFIED CONCUSSION EXTRADURAL HEMORRHAGE FOLLOWING INJURY, WITHOUT MENTION OF OPEN.

9 INTRACRANIAL WOUND, UNSPECIFIED STATE OF CONSCIOUSNESS EXTRADURAL HEMORRHAGE FOLLOWING INJURY, WITHOUT MENTION OF OPEN. INTRACRANIAL WOUND, NO LOSS OF CONSCIOUSNESS EXTRADURAL HEMORRHAGE FOLLOWING INJURY, WITHOUT MENTION OF OPEN. INTRACRANIAL WOUND, BRIEF (LESS THAN 1 HOUR) LOSS OF CONSCIOUSNESS EXTRADURAL HEMORRHAGE FOLLOWING INJURY, WITHOUT MENTION OF OPEN. INTRACRANIAL WOUND, MODERATE (1-24 HOURS) LOSS OF CONSCIOUSNESS EXTRADURAL HEMORRHAGE FOLLOWING INJURY, WITHOUT MENTION OF OPEN. INTRACRANIAL WOUND, PROLONGED (MORE THAN 24 HOURS) LOSS OF CONSCIOUSNESS. AND RETURN TO PRE-EXISTING CONSCIOUS LEVEL EXTRADURAL HEMORRHAGE FOLLOWING INJURY, WITHOUT MENTION OF OPEN. INTRACRANIAL WOUND, PROLONGED (MORE THAN 24 HOURS) LOSS OF CONSCIOUSNESS, WITHOUT RETURN TO PRE-EXISTING CONSCIOUS LEVEL EXTRADURAL HEMORRHAGE FOLLOWING INJURY, WITHOUT MENTION OF OPEN. INTRACRANIAL WOUND, LOSS OF CONSCIOUSNESS OF UNSPECIFIED DURATION EXTRADURAL HEMORRHAGE FOLLOWING INJURY, WITHOUT MENTION OF OPEN.

10 INTRACRANIAL WOUND, UNSPECIFIED CONCUSSION EXTRADURAL HEMORRHAGE FOLLOWING INJURY, WITH OPEN INTRACRANIAL WOUND, STATE. OF CONSCIOUSNESS UNSPECIFIED EXTRADURAL HEMORRHAGE FOLLOWING INJURY, WITH OPEN INTRACRANIAL WOUND, NO. LOSS OF CONSCIOUSNESS EXTRADURAL HEMORRHAGE FOLLOWING INJURY, WITH OPEN INTRACRANIAL WOUND, BRIEF. (LESS THAN 1 HOUR) LOSS OF CONSCIOUSNESS EXTRADURAL HEMORRHAGE FOLLOWING INJURY, WITH OPEN INTRACRANIAL WOUND, MODERATE (1-24 HOURS) LOSS OF CONSCIOUSNESS EXTRADURAL HEMORRHAGE FOLLOWING INJURY, WITH OPEN INTRACRANIAL WOUND, PROLONGED (MORE THAN 24 HOURS) LOSS OF CONSCIOUSNESS AND RETURN TO PRE- EXISTING CONSCIOUS LEVEL EXTRADURAL HEMORRHAGE FOLLOWING INJURY, WITH OPEN INTRACRANIAL WOUND, PROLONGED (MORE THAN 24 HOURS) LOSS OF CONSCIOUSNESS, WITHOUT RETURN TO PRE- EXISTING CONSCIOUS LEVEL EXTRADURAL HEMORRHAGE FOLLOWING INJURY, WITH OPEN INTRACRANIAL WOUND, LOSS. OF CONSCIOUSNESS OF UNSPECIFIED DURATION EXTRADURAL HEMORRHAGE FOLLOWING INJURY, WITH OPEN INTRACRANIAL WOUND, UNSPECIFIED CONCUSSION v1 Page 6 of 12.